实用医学杂志 ›› 2025, Vol. 41 ›› Issue (21): 3315-3321.doi: 10.3969/j.issn.1006-5725.2025.21.003

• 专题笔谈 • 上一篇    

免疫检查点抑制剂相关肾损伤的临床病理类型与发病机制

肖慧玲,何伟春()   

  1. 南京医科大学第二附属医院肾脏病中心 (江苏 南京 210000 )
  • 收稿日期:2025-04-14 出版日期:2025-11-10 发布日期:2025-11-13
  • 通讯作者: 何伟春 E-mail:heweichun@njmu.edu.cn
  • 作者简介:何伟春,主任医师,教授,博士研究生导师。现为南京医科大学第二附属医院肾病中心副主任、中国病理生理学会肾脏病专业委员会委员、江苏省研究型医院学会肾脏病精准诊治专业委员会委员、南京市医学会肾脏病专科分会委员、江苏省医学会罕见病学分会委员,担任江苏省及南京市医学会医疗事故鉴定专家组成员。擅长各种原发性和继发性肾脏疾病的诊断与治疗,主要研究方向为慢性肾脏病发病机制与临床诊疗。以第一作者、通信作者发表SCI论文18篇,2篇被F1000推荐,主编英文专著1部、研究生教材1部、副主编专著1部,参编10余部。获华夏医学科技奖三等奖1项、江苏省科技进步三等奖3项、二等奖1项。主持国家自然科学基金项目2项、江苏省自然科学基金项目1项,是江苏省高校“青蓝工程”中青年学术带头人培养对象,江苏省“六大人才高峰”高层次人才、江苏省“科教强卫工程”医学重点人才。
  • 基金资助:
    国家自然科学基金项目(31571169)

Clinical pathological types and pathogenesis of immune checkpoint inhibitor-related kidney injury

Huiling XIAO,Weichun. HE()   

  1. Center for Kidney Disease,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,Jiangsu,China
  • Received:2025-04-14 Online:2025-11-10 Published:2025-11-13
  • Contact: Weichun. HE E-mail:heweichun@njmu.edu.cn

摘要:

免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)是一类新型抗肿瘤药物,通过阻断免疫系统的内源性抑制信号发挥作用,激活T细胞对肿瘤的免疫应答,显著改善了肿瘤患者的预后,然而,由此引发的免疫相关不良事件(immune-related adverse events, irAEs)已成为不可忽视的问题。irAEs可累及包括肾脏在内的多器官系统,其中免疫检查点抑制剂相关急性肾损伤(ICI?associated acute kidney injury,ICI-AKI)是最常见的肾脏毒性表现。病理类型以急性间质性肾炎(acute interstitial nephritis, AIN)最为常见,此外还包括肾小球疾病及血栓性微血管病等非AIN类型。ICI-AKI的发病机制复杂,涉及免疫耐受失衡、自身反应性T细胞的异常激活、自身抗体产生及炎症因子等。ICI-AKI通常对早期糖皮质激素治疗反应良好,大多数患者可达到部分或完全缓解。因此,对疑似患者的及时评估、精准诊断及规范管理具有重要临床价值。深入理解ICIs相关肾损伤的临床病理特征及其免疫学机制,是优化早期识别、精准诊断和有效管理的关键。本综述旨在系统总结当前ICIs相关肾损伤的关键病理学发现,深入探讨其发生发展的免疫学机制,为临床实践提供理论依据与指导。

关键词: 免疫检查点抑制剂, 免疫相关不良事件, 急性肾损伤, 肾毒性, 病理类型

Abstract:

Immune checkpoint inhibitors (immune checkpoint inhibitors, ICIs), as new anti-tumour drugs, have significantly improved the prognosis of tumour patients by blocking the endogenous immune inhibitory signals and activating the immune response of T cells against tumours. However, the immune-related adverse events (irAEs) they cause have become a significant concern. irAEs can affect multiple organ systems, including the kidneys.Among these, immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI) represents the most common renal toxicity manifestation. The most common pathological type is acute interstitial nephritis (AIN). Non-AIN types, such as glomerular diseases and thrombotic microangiopathy, can also occur. The pathogenesis of ICI-AKI is complex, involving immune tolerance imbalance, abnormal activation of autoreactive T cells, autoantibody production, and inflammatory cytokines. ICI-AKI typically responds well to early corticosteroid therapy, with most patients achieving partial or complete renal recovery. Therefore, the timely evaluation, precise diagnosis, and standardized management of suspected cases hold crucial clinical value. A deep understanding of the clinical and pathological features and immunological mechanisms of ICI-related renal injury is the key to optimizing early identification, accurate diagnosis, and effective management. This review aims to systematically summarize the key pathological findings of current ICI-related kidney injury and deeply explore its immunological mechanisms of occurrence and development, providing theoretical basis and guidance for clinical practice.

Key words: immune checkpoint inhibitors, immune-related adverse events, acute kidney injury, nephrotoxicity, pathological type

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